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Heterogeneous Responses of Axillary Lymph Node Metastases to Neoadjuvant Chemotherapy are Common and Depend on Breast Cancer Subtype

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to analyze heterogeneous responses of axillary lymph node metastasis to neoadjuvant chemotherapy and to determine to what extent they differ between tumor subtypes (TN, HER2+, HR+/HER2−).

Methods

This retrospective, monocenter study included 72 consecutive, histologically node-positive breast cancers (cT1–4 cN1–3 cM0) diagnosed in the period from January 2015 to December 2016, who had received axillary lymph node dissection following neoadjuvant chemotherapy. All individual lymph node specimens were re-evaluated for the presence of tumor cells and chemotherapy effects to assess their response to neoadjuvant chemotherapy on an individual lymph node level according to the Sataloff classification.

Results

Heterogeneous axillary responses to neoadjuvant chemotherapy occurred in 47.2% of the included 72 patients. The partial response rate was significantly higher in HR+/HER2− tumors (74.2%) than in TN (28.6%) and HER2+ tumors (25.0%) (p < 0.001). The presence of at least one negative, completely responding lymph node in the axillary lymph node dissection specimen had a false-negative rate of 48.8% in predicting ypN0. It dropped below 10% if at least four completely responding negative lymph nodes were identified.

Conclusions

Our study shows that axillary heterogeneous response rates differ significantly between tumor subtypes.

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Funding

No funding was received in support of this work.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Breast Unit, University Women’s Hospital Heidelberg, Heidelberg, Germany

    Antonia Glaeser, Fabian Riedel MD, Sarah Hug MD, Benedikt Schaefgen MD, Michael Golatta PhD, Andre Hennigs PhD, Christof Sohn PhD & Joerg Heil PhD

  2. Institute of Pathology, University of Heidelberg, Heidelberg, Germany

    Hans-Peter Sinn MD

  3. Department of Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, PV, Italy

    Carlos Garcia-Etienne MD

  4. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Manuel Feisst

Authors
  1. Antonia Glaeser
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  2. Hans-Peter Sinn MD
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  3. Carlos Garcia-Etienne MD
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  4. Fabian Riedel MD
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Correspondence to Joerg Heil PhD.

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Ethical Standard

The study was approved by the ethics committee of the University of Heidelberg (reference number: S-241/2017). All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments.

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Glaeser, A., Sinn, HP., Garcia-Etienne, C. et al. Heterogeneous Responses of Axillary Lymph Node Metastases to Neoadjuvant Chemotherapy are Common and Depend on Breast Cancer Subtype. Ann Surg Oncol 26, 4381–4389 (2019). https://doi.org/10.1245/s10434-019-07915-6

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  • DOI: https://doi.org/10.1245/s10434-019-07915-6

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